Catering to the sailor-tourist in the early twentieth century Philippines: The Gob’s Guide to Manila

Introduction Insufficient sleep is pervasive in U.S. Navy (USN) sailors and has been associated with increased risk of injury and mood disturbances. As such, monitoring sleep and identifying modifiable targets that influence sleep in this population is essential. We examined the sleep of USN sailors during 9-months in port and explored the influence of different lifestyle behaviors on sleep. Methods Sailors (n = 101, 31 ± 7 years old [mean ± SD], 21% female) wore a commercial wearable sleep-tracking device (Oura Ring, Gen2) during a 9-month home port maintenance period (September 2021 – May 2022). During the study, the sailors slept at home and had periods working on the ship (on-hull; higher demands) and off the ship (off-hull; lower demands). Participants also completed 5 self-report surveys that assessed sleep quality (Pittsburgh Sleep Quality Index; PSQI) and multiple lifestyle behaviors including: hours of natural light exposure, hours of moderate/vigorous physical activity, and intake of caffeine, nicotine, and alcohol. Sleep outcome measures from the wearable device included total sleep time (TST), standard deviation of TST (SD TST), and sleep efficiency (SE). Linear mixed models were used to examine the effects of lifestyle behaviors on sleep. Timepoint and on/off-hull condition were also included as fixed effects, while participant was included as a random effect. Results Participants slept 6.5 ± 0.7 hours a night (6.2 ± 0.9 on-hull; 6.4 ± 0.8 off-hull; p > .05) and had slightly elevated PSQI scores that were higher on-hull (8.3 ± 4.6) than off-hull (6.5 ± 3.5; B = 1.83, Std. Error = 0.71, p = .01). Lifestyle behaviors were not significant predictors of PSQI, TST, SD TST, or SE (p > .05). Conclusion Lifestyle behaviors had weak relationships with self-reported and objective sleep outcomes in this exploratory analysis. Therefore, modifying lifestyle behaviors may not significantly influence sleep in USN sailors during home port periods. Still, additional behavioral targets (e.g., diet), specific aspects of behavioral outcomes (e.g., light exposure timing, exercise intensity), and other work-related factors (e.g., workload, schedule) that can affect sleep should be explored in future efforts. Support (if any) Military Operational Medicine Research Program (work unit no. N2010).

The study explores how sleep, sleep-related practices, and behaviors, in addition to various demographic and occupational characteristics, are related to overall mood of US Navy sailors when they are underway. Longitudinal assessment of US Navy sailors performing their underway duties (N = 873, 79.2% males, median age 25 years). Participants completed standardized questionnaires, wore wrist-worn actigraphs, and completed daily activity logs. Sailors who reported worse profile of mood states (POMS) total mood disturbance scores had shorter sleep duration, worse sleep quality, and more episodes of split sleep. The group with worse mood also reported more symptoms of excessive daytime sleepiness as well as more symptoms of insomnia. In addition to sleep results, sailors with worse mood also tended to be younger, more likely to use nicotine and tobacco products, and less likely to have an exercise routine when compared to sailors with better POMS scores. Finally, the group with worse POMS scores included more enlisted personnel, tended to work more hours per day, and were more likely to stand watch-especially on rotating watch schedules. The results found significant associations between the sleep practices and mood of sailors aboard US Navy ships. Numerous other demographic and occupational factors were also strongly associated with mood. This paper is part of the Sleep and Circadian Rhythms: Management of Fatigue in Occupational Settings Collection.

The purpose of this study was to evaluate the efficacy of the Escalation Workshop with a sample of US Navy sailors. Escalation is a one-session workshop designed to promote bystander behavior related to dating abuse. We conducted a two-arm RCT with follow-up at 4 and 8 months. Participants were 335 Navy sailors, recruited from two comparable ships based in the USA. The unit of randomization was the ship. The primary outcomes were as follows: (a) attitudes related to intervening as a bystander in dating abuse situations, (b) injunctive norms about dating abuse, (c) dating abuse-related prevention-oriented behaviors (e.g., such as posting dating violence prevention messages online), and (d) bystander behaviors including acting as a bystander to prevent peer self-harm, peer bullying, peer intoxication, or peer dating abuse, or being a proactive bystander and initiating conversations about dating abuse prevention with friends and others. Hierarchal linear models (HLMs) indicated that, compared to participants in the control group, participants in the intervention group demonstrated improvement in attitudes [β = .09, p < .001] and had more engagement than controls in prevention-oriented behavior at 8-month follow-up [β = 0.11, p < .01]. Those in the intervention group also reported larger increases than controls in bystander behavior related to peer self-harm, peer bullying, peer intoxication, and starting conversations about dating abuse. Results for dating abuse bystander behavior were mixed. At 4 months, workshop participation was marginally associated with increased bystander behavior with peers who had perpetrated dating abuse (β = 0.89, p = 0.06) and with peers experiencing physical or sexual dating abuse, or stalking or threats (β = 1.11, p = .07). However, workshop participation was not associated with increased bystander behavior with peers experiencing only physical abuse. The Escalation Workshop may be a promising strategy to promote change in dating abuse-related attitudinal change and prevention-oriented behavior, and bystander behavior with peers related to self-harm, bullying, intoxication, and some aspects of dating abuse prevention.

Introduction Approximately 18% of US Navy sailors are females. Research has shown gender-related differences in the prevalence of sleep disorders in active duty personnel (Foster et al., 2017). Specifically, insomnia, depression, and anxiety are more prevalent in females, while obstructive sleep apnea is more prevalent in males. We have studied the sleep patterns and fatigue levels of crew members on more than 30 US Navy ships. The current study focuses on gender differences in well-being, sleep-related behaviors, and psychomotor vigilance performance of sailors in the US Navy. Methods Using a longitudinal, naturalistic observation paradigm, data were collected from crewmembers on nine USN ships while performing their normal underway duties. Participants (N=1,056) tended to be young (on average 27 years of age), predominantly male (80.6%), and enlisted (84.8%). We assessed average daytime alertness (Epworth Sleepiness Scale), insomnia symptoms (Insomnia Severity Index), mood (Profile of Mood States), and sleep quality (Pittsburgh Sleep Quality Index). Sleep was assessed with actigraphy and logbooks. Sailors performed a 3-minute version of the Psychomotor Vigilance Task (PVT), which was built into their wrist-worn actigraph. Results Compared to males, female sailors reported more depressive symptoms (p=0.042) and less vigor (p&amp;lt;0.001). Females slept more (daily sleep duration: p&amp;lt;0.001) but their sleep was split into more episodes than their male counterparts (p=0.029). Fewer females reported a regular exercise routine (p=0.033). In addition, females report consuming fewer energy drinks (p=0.007), and using fewer nicotine products (p=0.013). Lastly, consistent with findings from civilian populations, female sailors had slower reaction times on the PVT (p&amp;lt;0.001) and experienced more lapses combined with false starts (p&amp;lt;0.001) than their male counterparts. Conclusion Compared to their male peers, female sailors tend to report higher levels of depression and lower levels of vigor. They experience more pronounced split sleep, are less likely to report having an exercise routine, and have poorer performance on the PVT. Fewer females report using energy drinks and nicotine products. Support This research was supported by the Naval Medical Research Center’s Advanced Medical Development Program, the US Navy 21st Century Sailor Office, and the US Navy OPNAV N1.

Introduction On United States Navy (USN) ships, most sailors are shift workers, required to support 24/7 operations. However, ~15% of the ship’s company are solely dayworkers who do not work in shifts. It is often assumed that the quality of life for dayworkers is better than that of shift workers. This study compared the well-being of dayworkers with that of shift workers. Methods Longitudinal, naturalistic observations were made of sailors (N=926; 18-59 years of age, ~80% males, ~84% enlisted personnel) on seven US Navy ships while performing their normal underway duties. Sleep-related attributes (actigraphy, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index), mood (Profile of Mood States), and work/rest patterns were assessed. Results Dayworkers (DW; n=98) were on average older (p=0.001) and more senior (p=0.001) than shift workers (SW). Of the dayworkers, 31% reported elevated daytime sleepiness (SW:45.5%; p=0.008), 64.2% were poor sleepers (SW:82.6%; p&amp;lt;0.001), and 26.3% had ISI score≥15 (SW:24.8%; p=0.782). Also, 13.8% of the dayworkers had ESS&amp;gt;10 and ISI≥15 (SW:16.8%; p=0.626).Dayworkers had better mood (Total Mood Disturbance, anger/hostility, vigor, fatigue; all p&amp;lt;0.050), slept more (7.03±0.74hrs sleep/day; SW:6.52±1.03hrs; p&amp;lt;0.001) and had more consolidated sleep (1.1±0.3 sleep episodes/day; SW:1.4±0.6; p&amp;lt;0.001). Yet, split sleep was commonplace for both groups (DW:~62%; SW:~92%).The two groups do not differ (all p&amp;gt;0.300) in their use of caffeinated beverages (82%-86%), use of nicotine products (30%-36%), or having a regular exercise routine (69%-75%). In both groups, ~9% of sailors drank caffeinated beverages, used nicotine products and did not have an exercise routine (p=0.999). Dayworkers worked 10.1 hours/day, i.e., 1.7 hours/day less than watchstanders (p&amp;lt;0.001). Conclusion Quality of life of dayworkers is a bit better when compared to shift workers, but sleep-related issues are evident in almost all US Navy sailors. Living and working on a naval vessel takes a toll on almost everyone aboard. A culture change is required! Support Supported by the Naval Medical Research Center’s Advanced Medical Development Program, the US Navy 21st Century Sailor Office, and the US Navy OPNAV N1.

This field study (a) assessed sleep quality of sailors on the U.S. Navy (USN) ships while underway, (b) investigated whether the Pittsburgh Sleep Quality Index (PSQI) scores were affected by occupational factors and sleep attributes, and (c) assessed whether the PSQI could predict impaired psychomotor vigilance performance. Longitudinal field assessment of fit-for-duty USN sailors performing their underway duties (N = 944, 79.0% males, median age 26 years). Participants completed questionnaires, wore actigraphs, completed logs, and performed the wrist-worn 3-min Psychomotor Vigilance Task (PVT). Sailors slept on average 6.60 ± 1.01 h/day with 86.9% splitting their sleep into more than one episode/day. The median PSQI Global score was 8 (interquartile range [IQR] = 5); 80.4% of the population were classified as "poor sleepers" with PSQI scores >5. PSQI scores were affected by sailor occupational group, rank, daily sleep duration, and number of sleep episodes/day. Sleep quality showed a U-shape association with daily sleep duration due to the confounding effect of split sleep. Sailors with PSQI scores >9 had 21.1% slower reaction times (p < 0.001) and 32.8%-61.5% more lapses combined with false starts (all p < 0.001) than sailors with PSQI scores ≤9. Compared to males and officers, females and enlisted personnel had 86% and 23% higher risk, respectively, of having PSQI scores >9. Sailors in the PSQI > 9 group had more pronounced split sleep. Working on Navy ships is associated with elevated PSQI scores, a high incidence of poor sleep, and degraded psychomotor vigilance performance. The widely used PSQI score>5 criterion should be further validated in active-duty service member populations.

US Navy Sailors Modify Their Eating Behaviors to Pass Cyclic Physical Readiness Tests

The purpose of this paper is to demonstrate the feasibility and utility of developing economic cost models for noise-induced hearing loss (NIHL). First, we outline an economic model of NIHL for a population of US Navy sailors with an "industrial"-type noise exposure. Next, we describe the effect on NIHL-related cost of varying the two central model inputs--the noise-exposure level and the duration of exposure. Such an analysis can help prioritize promising areas, to which limited resources to reduce NIHL-related costs should be devoted. NIHL-related costs borne by the US government were computed on a yearly basis using a finite element approach that took into account varying levels of susceptibility to NIHL. Predicted hearing thresholds for the population were computed with ANSI S3.44-1996 and then used as the basis for the calculation of NIHL-related costs. Annual and cumulative costs were tracked. Noise-exposure level and duration were systematically varied to determine their effects on the expected lifetime NIHL-related cost of a specific US Navy sailor population. Our nominal noise-exposure case [93 dB(A) for six years] yielded a total expected lifetime cost of US $13,472 per sailor, with plausible lower and upper bounds of US $2,500 and US $26,000. Starting with the nominal case, a decrease of 50% in exposure level or duration would yield cost savings of approximately 23% and 19%, respectively. We concluded that a reduction in noise level would be more somewhat more cost-effective than the same percentage reduction in years of exposure. Our economic cost model can be used to estimate the changes in NIHL-related costs that would result from changes in noise-exposure level and/or duration for a single military population. Although the model is limited at present, suggestions are provided for adapting it to civilian populations.

Reviewed by: Colonial Dis-Ease: US Navy Health Policies and the Chamorros of Guam, 1898-1941 Alison Bashford Anne Perez Hattori . Colonial Dis-Ease: US Navy Health Policies and the Chamorros of Guam, 1898-1941. Pacific Islands Monograph Series, no. 19. Honolulu: University of Hawai'i Press. 2004. xiv + 239 pp. Ill. $45.00 (0-8248-2808-9). This book is one answer to the question posed some time ago by Warwick Anderson in the pages of this journal: "Where is the postcolonial history of medicine?" Although the author does not quite locate her book as "postcolonial," she might well have: it is certainly an important case study in the growing historiography on U.S. military-colonial and tropical medicine in the early twentieth century—but unlike most, the fundamental research question here concerns public health and cross-cultural encounter. In a personalized coda to the book, Anne Perez Hattori mentions the uniqueness of the Guam experience, and in terms of the history of public health and of colonial and tropical medicine, this seems a fair claim. U.S. colonial administration of Guam was sudden, beginning in 1898 (squarely in the "tropical medicine" moment). It was total, in the sense that the whole island (territory and population) was under U.S. Navy administration, including Navy health and hygiene ordinances. And, as the author intriguingly points out, pre–World War II U.S. colonialism has been glossed by Chamorro memories of "American Liberation" in the war, making a critical approach to the earlier period not always welcomed. Add to this the scholarly challenge of researching and assessing the effect of earlier centuries of Spanish colonialism on indigenous health practices, and what emerges is a perfect opportunity to put medical history, colonial history, Pacific history, and U.S. history hard to work. The result is a carefully researched and neatly structured book. After several contextualizing chapters (which could have had slightly more analysis of the significance of "Navy" colonialism, rather than the more familiar Army–tropical medicine nexus), the author presents close studies of four different sites of [End Page 781] intervention: the management of Hansen's disease; the regulation of Chamorro midwifery and maternity; the Susana Hospital, the first hospital for women and children on Guam; and the (inevitable) hookworm campaign. Some of this is familiar in twentieth-century public health historiography, even if we have here excellent examples: the criminalization discourses in management of the infected, in particular those with Hansen's disease; the link between cleanliness, racialization, and modernization; the overriding of "lay" women's health practices and epistemologies by those of expert men; the surveillance of children and the use of education to promote hygienic conduct. In each chapter, the reader finds concrete information about the plans and ambitions of Navy personnel—realized and unrealized—and a real sense of the day-to-day implications of this sanitary administration for the Chamorros, none of whom, it seems, was untouched by the imperative of health. Admirably, Perez Hattori presents us with many perspectives: those of Chamorro children, Chamorro elite and entrepreneurs, Chamorro midwives and healers who were being displaced, Chamorro doctors and nurses whose lives were enfolded by the modern opportunities for work, education, and identity; and those of the Navy personnel themselves, as well as the U.S. wives' active philanthropic interests in women and children's health. While the U.S. Navy medical and sanitary measures are often critiqued, there is little automatic demonizing or valorizing of any of the historical agencies and actors: there is, for example, much substantiation of Chamorros' responding defiantly, opportunistically, and deferentially to Navy requirements. For medical historians and students, this is an interesting study in historical method, as well as offering a fresh substantive site for thinking about U.S. colonial medicine. In assessing indigenous practices, and Spanish influence from the seventeenth century, the author has been part anthropologist, relying on the rich scholarship of Pacific cross-cultural encounter. And she has heavily utilized oral histories, capitalizing on her own Chamorro knowledge. Each of these approaches supplements the seeming flood of archival data available—a flood precisely because Guam was so heavily administered, and because sanitation and hygiene were such a...

The research dives into similarities between historical events in the early twentieth and twenty-first centuries, drawing connections to Borys Hrinchenko’s inspirations which resonate with contemporary efforts in resisting russian occupation, emphasizing the struggle for Ukrainian independence, identity, and freedom through primarily ideological, cultural, national, and linguistic means. The article highlights the leading pedagogical ideas of the scientific and journalistic heritage of Borys Hrinchenko, a prominent Ukrainian linguist, writer, poet, playwright, publicist, critic, ethnographer, educator, and public figure of the late nineteenth – early twentieth centuries. The author focuses on various aspects of the scientist’s contributions, including ethnographic research and methodological systematization of Ukrainian folk art, social endeavors aimed at common societal objectives, educational perspectives, and pedagogical intentions. Additionally, the emphasis is on humanizing personal and social interactions among individuals through the promotion of universal moral ideals and spiritual values, among other aspects. The article provides characteristics of educational concepts related to the national upbringing of Ukrainian youth within Borys Hrinchenko’s scientific and journalistic heritage. It outlines the pedagogical discussions on intergenerational transmission in the realm of Ukrainian studies during the specified period. The author attempts to reinterpret the eminent thinker’s persona in intrinsic harmony with well-known figures from the intellectual elite of that era. Significant attention is devoted to the alignment of creative concepts between Borys Hrinchenko and Ivan Franko. The article highlights Kamenyar’s extensive praise for Hrinchenko, mentioning his resilience challenging criticism, often hostile, and his consistent profound love for Ukraine and “sincere democracy” in all his writings. Specific examples are presented to illustrate Hrinchenko’s aimed critique of Khrystyna Alchevska’s idleness, particularly in the context of russifying Ukrainian schools and publishing her books in russian. The research offers an entirely different interpretation of the critical perspective on certain intellectuals’ scientific and literary works from the relevant period. This perspective was aimed at the promotion of Ukrainian studies and national education. The article explores certain aspects of Hrinchenko’s role as a teacher in a rural school, drawing from historical and scholarly references. It emphasizes the strong connection between two generations of the Ukrainian national movement – Borys Hrinchenko and Dmytro Doroshenko – by analyzing their common efforts. The author highlights their effective collaboration in developing the Ukrainian independent press, public engagement, educational initiatives, and shaping the Ukrainian people’s national consciousness and identity.

Omicron and its subvariants have steadily gained greater capability of immune escape compared to other variants of concern, resulting in an increased incidence of reinfections even among vaccinated individuals. We evaluated the antibody response to Omicron BA.1, BA.2, and BA.4/5 in US military members vaccinated with the primary 2-dose series of Moderna mRNA-1273 in a cross-sectional study. While nearly all vaccinated participants had sustained spike (S) IgG and neutralizing antibodies (ND50) to the ancestral strain, only 7.7% participants had detectable ND50 to Omicron BA.1 at 8 months postvaccination. The neutralizing antibody response to BA.2 and BA.5 was similarly reduced. The reduced antibody neutralization of Omicron correlated with the decreased antibody binding to the receptor-binding domain. The participants' seropositivity to the nuclear protein positively correlated with ND50. Our data emphasizes the need for continuous vigilance in monitoring for emerging variants and the need to identify potential alternative targets for vaccine design.

As part of a broader study, this work investigates if habitual exercise protects against mood deterioration and daytime sleepiness in Sailors during underway operations. Previous work has shown that unfavorable watchstanding schedules have negative effects on sleep quality, subjective levels of fatigue, mood, and psychomotor vigilance performance. The participants were crewmembers of a U.S. Navy aircraft carrier (N=193), working on two different watchstanding schedules. Epworth Sleepiness Scale (ESS) and profile of mood state (POMS) scores were compared between participants who reported exercising &lt; 3 times/week and ≥3 times/week. During the course of the underway, ESS and POMS scores changed more favorably for the crewmembers who exercised 3 or more times/week compared to their peers who exercised less. The effect of working out was more prominent in the less favorable shift schedule. These results suggest that habitual exercise can be a protective buffer against some of the negative effects of watchstanding while underway.

Submariners face many environmental and operational challenges to maintaining good sleep, including suboptimal lighting, shift work, and frequent interruptions. Anecdotally, many Sailors consume caffeine to alleviate the effects of poor sleep on alertness, mood, and performance; however, caffeine itself may also degrade sleep quantity and/or quality. This study provides the first exploration of the potential relationship between caffeine use and sleep onboard submarines. Objective measures (wrist actigraphy, available from 45 participants), self-report sleep metrics, and self-reported caffeine consumption were collected from 58 US Navy Sailors before and during a routine submarine underway at sea lasting 30 days. Contrary to expectations, less caffeine was reportedly consumed at sea (232.8 ± 241.1 mg) than on land prior to the underway (M = 284.4 ± 251.7 mg; X2 (1) = 7.43, p = 0.006), positive rather than negative relationships were observed between caffeine consumption and sleep efficiency (F = 6.11, p = 0.02), and negative relationships were observed between caffeine consumption and wake after sleep onset (F = 9.36, p = 0.004) and sleep fragmentation (F = 24.73, p < 0.0001). However, in contrast, higher caffeine consumption was also negatively related to self-reported sleep duration while at sea (F = 4.73, p = 0.03). This observational study is the first to measure relationships between caffeine consumption and sleep quantity and/or quality in a submarine environment. We propose that the unique submarine environment and the unique caffeine consumption patterns of submariners should be considered in the development of potential countermeasures for sleepiness.

Introduction Obstructive sleep apnea (OSA) and insomnia are prevalent sleep disorders, known to negatively impact sleep and well-being in civilian populations. Studies of these sleep disorders in military populations have focused on individuals seeking treatment for a sleep disorder, rather than the general active-duty service member (ADSM). In this study, we investigated the prevalence of OSA and insomnia in U.S. Navy sailors serving on surface ships. Methods We analyzed pre-collected data from 548 fit-for-duty sailors (MD age=25 years, IQR=9; 79.4% males) serving on nine US Navy surface ships. Sailors reported their demographic information, health-related habits, and whether they had been diagnosed with OSA and/or insomnia. Sleep was assessed with wrist-worn actigraphy (371 sailors). Results Approximately 66.8% of sailors reported having an exercise routine, 83.6% reported drinking caffeinated beverages, and 29.1% used nicotine products. In terms of disorders, 15 (2.7%) male sailors reported having been diagnosed with OSA, 12 (2.2%) with insomnia (8 males, 4 females), and one (0.2%) male sailor with comorbid insomnia and OSA. Compared to sailors without a sleep disorder, sailors with OSA were older (MD=34 years, IQR=7; p&amp;lt;0.001) and had a higher proportion of nicotine users (53.3%) (p=0.041). Sailors with insomnia did not differ from sailors with no sleep disorder in terms of demographics and habits. The average daily sleep duration was 6.4±1.0 hours, which did not differ between disorder groups. However, sailors with insomnia had more sleep episodes per day (MD=1.7; IQR=0.9) than sailors without a sleep disorder (MD=1.3, IQR=0.5; p=0.042). Conclusion Only ~5% of the sailors in our study reported a diagnosis of OSA and/or insomnia, whereas one in three people in the general population has a sleep disorder. Notably, all sailors, regardless of sleep disorder diagnosis, exhibited short sleep durations. Previous studies of ADSMs found that ~48% reported poor enough sleep quality to meet the diagnostic criteria for a sleep disorder. Thus, our results suggest that, despite evidence that many Sailors exhibited sleep problems, sleep disorders are significantly underdiagnosed in ADSMs. Support (If Any) This work was supported in part by the Naval Medical Research Center's Naval Advanced Medical Development Program (MIPR N3239820WXHN007).

The final decades of the nineteenth century were marked by diplomatic confrontations between Chile and the United States. In 1891 the killing of US Navy sailors in a riot in Valparaíso threatened to provoke armed conflict, an event known as the Baltimore Crisis. This article investigates how William Russell Grace, the head of a merchant firm based in New York, played a central role in negotiating between Chile and the United States. By placing his activities in a transnational framework, Grace responded to the demands of multiple nation-states in the Americas. Observing changes in Grace's transnational economic infrastructure can help to identify larger long-term shifts in diplomacy and power on South America's Pacific coast in the late nineteenth century, especially Chile's emergence as a regional hegemon. The actions of Grace also raise larger questions regarding the power of business in the Americas in the late nineteenth century, especially with regard to growing US interests in the region.